Two prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5-23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses' Health Study (NHS) and 27 428 men from the Health Professionals Follow-up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person-years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age-adjusted model.

In non-O individuals, plasma levels of factor VIII-von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII-vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions

Doctor’s Day celebrations organised by Heart Care Foundation of India and eMedinewS

National News

Infectious diseases experts to meet

A panel of international experts in infectious diseases has arrived in the city to put their heads together with doctors here and devise a strategy to fight anti-microbial resistance through suitable policies and guidelines for the use of antibiotics. The 2-day conference of the Clinical Infectious Diseases Society was inaugurated in the city on Friday by Dr Prathap Reddy, chairman, Apollo hospitals. Non-communicable diseases like diabetes and heart disease may be the more glamorous and therefore more visible aspect of healthcare right now, but infectious diseases are still the leading cause of death in the country. “The development of antibiotics and other anti-microbials has played an important role in the fight against infectious diseases, but microorganisms can develop resistance to the drugs used against them. The more widely antibiotics are used, the more likely it is that antimicrobial-resistant strains of microorganisms will emerge,” stressed Dr Prathap Reddy. The workshops and scientific sessions will discuss issues like childhood immunization, as half the population of Indian children is not immunized fully. The problem of infection control in the hospital and ICU set-up will also be deliberated upon. Representatives from WHO as well as the state and central governments will be attending the conference.

“This is the second annual conference of the society, and we aim to increase the awareness on infectious diseases,” said Dr V Ramasubramanian among general practitioners and family physicians. There are special tracks for microbiologists and special sessions of the treatment of Tuberculosis and HIV, apart from other tropical diseases,” said Dr V Ramasubramanian, consultant infectious disease specialist. (Source: Deccan Chronicle, Aug 25, 2012)

MUMBAI: The state government's soon-to-be-notified rules to boost cadaveric organ transplant got many bouquets in the medical fraternity, but some experts were sceptical. On August 22, TOI reported the state government's plan to use driving licences as organ donor cards. A government resolution is expected in the next couple of months making it mandatory for people to state whether or not they want to donate their organs in case of brain death. Other measures include mandatory reporting of brain deaths in each hospital's ICU, appointment of transplant coordinators and recognising small nursing homes with even one ICU and one operation theatre as organ retrieval centres. On Thursday, a delegation of doctors from various medical organizations such as the Indian Medical Association (IMA), Narmada Kidney Foundation and the Indian Society of Organ Transplantation (ISOT), met deputy chief minister Ajit Pawar and chief secretary Jayant Banthia. Dr Jayesh Lele, secretary of the state IMA, who was present at the meeting, said, "Stating donation wish on the driver's licence is a good move. We also want minimum hassles for families that donate organs. We have asked the government to ensure that organ retrieval centres are present in every locality with a population of over 50,000.'' Dr Sujata Patwardhan, who represented ISOT, said, "We underlined the need for identifying a few people in the police and railway police force as nodal officers. These senior officers can help in quickly disseminating information and paperwork throughout the force.'' But some experts were sceptical about the impact of such measures. "Although Spain tried to introduce compulsory donation, the country largely depends on counseling to get consent for organ donation,'' said a senior doctor who didn't want to be named. (Source: TOI, Aug 24, 2012)

Leukoaraiosis, a pattern of patchy brain white matter seen on structural magnetic resonance imaging (MRI), is not an innocuous sign of aging, according to neuroscientists at the Mayo Clinic in Rochester, Minnesota, who have shown that it may represent a pathological process that alters normal brain activity and possibly distorts results from functional MRI. The condition is so common, especially among older individuals, on routine T2-weighted fluid attenuated inversion-recovery (FLAIR) imaging that radiologists previously dismissed it as unidentified bright objects or described its presence as microvascular ischemic disease, according to Kirk M. Welker, MD, head of functional MRI at the Mayo Clinic in Rochester. (Source: Medscape)

Two recent cases of primary amoebic meningoencephalitis (PAM) show that municipal tap water can harbor the amoeba responsible for the fatal disease, according to CDC researchers. (Source: Medpage Today)

German researchers suggest that therapeutic platelet transfusion could become a new standard of care in patients with hematological malignancies who receive autologous stem cell transplantation. However, prophylactic platelet transfusion should remain the standard for patients with acute myeloid leukemia, they report in the Lancet. The researchers, led by Hannes Wandt, MD, from the Klinikum Nuremberg Nord, in Germany, also stress that the therapeutic strategy should be used only where staff are well educated and experienced in the new approach and can react quickly to the first signs of central nervous system (CNS) bleeding. (Source: Medscape)

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Relieve stress by changing the interpretation

Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves either changing the situation, changing the interpretation or taming the body the yogic way in such a way that stress does not affect the body.

Saline infusion sonohysterography (SHG) consists of imaging the uterus and uterine cavity using ultrasonography while sterile saline is instilled into the uterine cavity. The purpose of sonohysterography is to detect abnormalities of the uterus and endometrial (uterine) cavity.

Blood transfusion is generally not required in most elective surgeries as it does not result in blood loss that patient can not tolerate.

There is rarely justification for the use of preoperative blood transfusion simply to facilitate elective surgery.

A significant degree of surgical blood loss can often safely be incurred before blood transfusion becomes necessary, provided that the loss is replaced with intravenous replacement fluids to maintain normovolemia.

Blood loss and hypovolemia can still develop in the postoperative period. Vigilant monitoring of vital signs and the surgical site is an essential part of patient management.

Have you ever wondered how elite people think? Through a short, inspiring speech below, Jim Rohn leads us into the spirit world of highly successful entrepreneurs. Here to strengthen our spirit! Yes we can!! An enterprising person is one who comes across a pile of scrap metal and sees the making of a wonderful sculpture. An enterprising person is one who drives through an old decrepit part of town and sees a new housing development. An enterprising person is one who sees opportunity in all areas of life.

To be enterprising is to keep your eyes open and your mind active. It’s to be skilled enough, confident enough, creative enough and disciplined enough to seize opportunities that present themselves… regardless of the economy.

A person with an enterprising attitude says, “Find out what you can before action is taken. Do your homework. Do the research. Be prepared. Be resourceful. Do all you can in preparation of what’s to come. Enterprising people always see the future in the present. Enterprising people always find a way to take advantage of a situation, not be burdened by it. And enterprising people aren’t lazy. They don’t wait for opportunities to come to them, they go after the opportunities. Enterprise means always finding a way to keep yourself actively working toward your ambition.

Enterprise is two things. The first is creativity. You need creativity to see what’s out there and to shape it to your advantage. You need creativity to look at the world a little differently. You need creativity to take a different approach, to be different. What goes hand-in-hand with the creativity of enterprise is the second requirement: the courage to be creative. You need courage to see things differently, courage to go against the crowd, courage to take a different approach, courage to stand alone if you have to, courage to choose activity over inactivity.

And lastly, being enterprising doesn’t just relate to the ability to make money. Being enterprising also means feeling good enough about yourself, having enough self worth to want to seek advantages and opportunities that will make a difference in your future. And by doing so you will increase your confidence, your courage, your creativity and your self-worth, your enterprising nature.

A person who wears contact lenses (CL) should be aware about the importance of good hygiene to prevent eye infection. There are growing number of reports of simple bacterial eye infection to devastating vision threatening acanthamoea keratitis caused by an amoeba - a parasite found in almost all soil, fresh water, swimming pool and sea water. To avoid these complications one should strictly follow these simple hygiene tips:

The hand should be washed with soap before inserting the lens in the eye or removing it from the eye.

Finger nails should be trimmed to avoid scratches on the lens.

The CL should be cleaned with multi purpose solution before and after use and it should be stored in that solution. The multi purpose solution cleans the CL and removes the protein deposits on the lens which comes from the tear.

Even if the CL are of the daily disposable type, they should be removed before going to bed.

Do not wash CL with simple tap water and do not lubricate it with saliva.

The CL wearers are at high risk if they swim, shower or bathe while wearing their CLs. The amoebic parasite can become trapped between the CL and cornea allowing it to penetrate into deeper layers of cornea leading to intractable corneal ulcer or even panophthalmitis with blindness.

Situation: A patient missed her last dose of hepatitis B vaccine as she was out of station at 6th month. Reaction: Oh my God! Why was the vaccine not given between 4–6 months? Lesson: Make sure that all patients are given the complete vaccine regimen. The correct regimen is 0, 1–2 months and 4–months.

Never feel bad when people remember you only in their bad times. It is because they think you as a candle in the darkness of their life.

Legal Question of the Day (Dr M C Gupta)

Q. Can a person who has a Diploma in Clinical Pathology do the following without any legal objection?

a. Report histopathology specimens
b. Open a pathlab and sign reports
c. Operate and head a blood bank

Ans.

The person in question has to abide by the rules set by the employer who, in turn, may like to follow the guidelines of the quality control organisations.

A DCP is an expert in clinical pathology which is different from histopathology. There may be problems with his reporting of histopathology slides etc.

A DCP is certainly competent to open a pathlab and sign reports.

The Drugs and Cosmetics Rules, 1945, do not lay down any qualifications for running a blood bank but the person concerned will have to abide by any regulations or instructions or requirements that may be laid down for this purpose by the licencing authority under the Drugs and Cosmetics and Rules.

Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching?

A. TURP is the most common operation for BPH.
B. Explain the purpose and function of a two-way irrigation system.
C. Expect bloody urine, which will clear as healing takes place.
D. He will be pain free.

Yesterday’s Mind Teaser: Assessing the laboratory findings, which result would the nurse most likely expect to find in a client with chronic renal failure?

What are the viscera samples to be taken for chemical analysis by the doctor conducting the autopsy?

The majority of poisons are taken orally and the poison due to water content/liquids is likely to be present in the stomach and intestinal contents and their walls. After absorption all poison pass through the liver, which is the major detoxifying organ in the body and has the power of concentrating many poisons and making them identifiable when the blood and urine concentrations may have declined to very low levels. The kidney, being the organ of excretion, contains large amounts of poison, which is excreted into the urine. The following viscera are preserved in case of any suspected or evident case of death due to poisoning.

Stomach and its contents. If the stomach is empty the wall should be preserved.

A study published in journal Archives of Internal Medicine has shown that people who regularly take painkiller drugs, ibuprofen or naproxen, are 51 percent more likely to develop kidney cancer. There is no increased risk from taking aspirin or paracetamol, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

The mechanism through which painkillers could cause kidney disease is the inhibition of prostaglandin synthesis with resulting papillary and tubular injury, and ultimately damage to DNA.

The study analyzed data from 77,525 women in the Nurses' Health Study and from 49,403 men in the Health Professionals Follow-up Study.

The risk was related to the duration of use of the painkiller. It was 19 percent lower if the painkiller was used for more than four years and less than ten years. The risk increased by 36% when the pain killer was used for more than four years. The risk increased almost three times for those who used these drugs regularly for 10 years or more.

The good news is that Kidney cancer is uncommon so the risk is small for average users. Two other important causes of kidney cancer are obesity and smoking. So people on painkillers should not smoke and should keep their weight under control to prevent kidney cancer.

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org